Center for Rehabilitation Science and Engineering

Study Information

Assessing pain in persons with polytrauma and differing cognitive levels: Intensity scale utility and reliability

Funding source: 

William Walker

William Walker
(804) 675-5625

Polytrauma patients usually have pain during the rehabilitation course. Pain can be quantified; it is no longer considered a purely subjective experience that is not available for reliable and valid assessment. Optimal pain management, via rational diagnostic and intervention decisions, can only be achieved through the use of a valid and clinically relevant measurement instrument. These tools enable the clinician to assess the effectiveness of interventions and improve the quality of pain management. Reliable self-report pain assessment tools have been demonstrated for cognitively intact adults, and have been studied in children and elderly adults with dementia. There is no systematic, validated method for pain assessment in the cognitively impaired, particularly in persons with traumatic brain injury (TBI). Anecdotal observations suggest that persons with TBI have a difficult time discriminating and expressing the intensity of their pain and have a variable memory of their pain experiences. TBI patients have deficits in attention, memory, communication, and self-awareness—all of which are important for accuracy in reporting pain intensity. The level of cognitive demand involved in current pain assessment tools may render them unreliable or not applicable in persons recovering from TBI. In this study, polytrauma patients without TBI are included to serve as cognitively intact controls for comparison. The purpose of this study is to assess the utility and reliability of four pain assessment instruments during the rehabilitation of persons with polytrauma and to examine the the influence of cognitive impairment. The ultimate goal of this study is to improve outcomes by providing evidence-based clinical care recommendations for pain intensity scale use in polytrauma patients undergoing rehabilitation.